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This study seeks to compare rates of blood lithium monitoring with rates of lithium prescription collection in order to evaluate whether identifying patients with low frequency of monitoring could alert clinicians to poor prescription collection. It examines whether routine monitoring of lithium prescription pick‐up would be likely to reduce admissions to hospital, as a way of identifying those who were poorly adherent with treatment. It also ascertains the frequency of lithium toxicity and its outcomes.

The frequency of monitoring of lithium was assessed through laboratory results of 773 patients. A sub‐sample of 119 patients on lithium was found through general practice records and the rates of medication collection determined. Admission data were examined to assess whether this was related to a failure in blood monitoring or prescription collection.

A total of 87 per cent of the GP group had lithium levels measured at least twice a year and 84 per cent collected more than 80 per cent of prescriptions. It was found that those patients not collecting their prescriptions were a different group from those who did not have their blood levels monitored. Admission rates were not higher in those who were less efficient at picking up prescriptions. Two per cent of the total sample had lithium levels above 1.6 mmol l⁻¹. There were no fatalities associated with high levels.

It is important to assess the real potential benefits of additional monitoring rather than assuming that increased surveillance will improve the outcome.

The purpose of this article is to examine reasons given by Mental Health Review Tribunals for discharging patients from detention and the effect the length of detainment had on the immediate outcome of discharged patients and to examine the effect on outcome from quality of reports and sources of evidence presented to the MHRTs.

All documentation pertaining to MHRTs heard in the Cambridge area over a 12‐month period were reviewed.

A quarter of tribunals heard were discharged, as they did not fulfil the legal criteria for detention. RMO non‐attendance was significant in this group. Unfavourable short‐term outcomes suggest that half of these discharges were premature. Improved aftercare compliance was associated with longer duration on a Section of the Mental Health Act prior to MHRT discharge.

This study reflects practice in the service (with a relatively small number of in‐patient sections) and may not be generalisable to other populations.

Improvement in the quality of evidence including risk assessments provided at tribunals should prevent premature discharges whilst maintaining the balance between civil liberties and good clinical care.

This paper highlights the need for improvement in clinical practice and training. Whilst it is primarily of interest to doctors, all professionals involved in MHRTs can learn from it.